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L.C.H.

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L.C.H. last won the day on June 24

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    AP/CP general pathologist, BB medical director

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  1. OK i dont really understand this, but i asked for more specifics - and our backup computers are evidently attached to the network but in a weird limited fashion where they get a solitary incoming dump every four hours, of BB data, but otherwise do not receive network activity, and have no "outgoing" channel. when we were hacked, one was due for a dump and got hacked, the other was instantly quarantined off-line and so had almost all (except the last few hours worth) of BB data. also was just told it is also now stashed in some quarantined part of the cloud? this is waaaay over my head in terms of IT though. sorry i cant explain it any better :-(
  2. Our inpatient consents are good for the duration of the admission. Outpatient consents are only good for the one visit, with two exceptions: 1) A onc/chemo pt, where the consent covers the time period of the entire outpatient chemo course 2) A pregnant pt, where the consent covers the entire outpatient portion of the pregnancy (usually chronically anemic women who are not responding to iron and need occasional pRBCs to bump up). That consent doesnt cover the admit for delivery though - that's a separate consent (hello, DIC MTPs!)
  3. We tell our clinicians to do exactly that, yes. Likely it won't turn into an anaphylactic event, but it could, so STOP and initiate a transfusion workup. Give benadryl and watch the patient. For future transfusions, pre-treat with benadryl - even though it's likely a response to that one specific donor's plasma proteins, and a bag from a different donor may not provoke a reaction.
  4. In terms of hacking- we have two offline PCs, one here and one at our sister hospital, that contain backups of BB data for both hospitals (dont know how often we back it up though). we were hit by ransomware last June (downtime for a week in the middle of COVID, yay)and then found out IT had connected one of those two "offlines" to the network, and it was gone. We still had one lonely functioning PC, tho, with the entire systems' BB data, adn it got us through what was otherwise a very, very dicey time.
  5. thanks for all the responses! looks like most folks, like us, have the KBs read in hematology. And the inspector was OK with it; i think he'd just been looking at our BB personnel competency forms, but when he asked for the KB staff competencies he didnt like the (slightly different) format that our heme dept uses. He was a very seasoned inspector, so when he said BB, not heme, most often reads KBs, I just got curious if our institution is really an outlier in that respect. Seems not!! thanks!
  6. Greetings all - We are having an AABB inspection, and a curious question has come up. The inspector is accustomed to KBs being read by blood bank personnel, so any issuance of RhIg (more than the typical vial) is based ona result coming out of blood bank, and acted on by blood bank. However, in our lab, KBs are read by heme, and it's now created some confusion around which lab section 'owns' the competencies. Our heme lab uses a slightly different format for competencies (a problem in and of itself, but not the issue at hand), and the inspector is a bit discomfited by this. I have only worked in two hospitals, and in both, KB was read by heme but actedf on by BB. and this question simply hasnt come up during inspections previously. so as an informal survey, I am just curious - which lab section reads and results your KBs?
  7. we require two types before issuing type-specific blood, and has to be two different samples from two different sticks. we bill for both.
  8. "Interesting topic, we had a 32 bed NICU and I don't remember ever transfusing platelets." we have a larger NICU, but have transfused plts to babies twice already this week, so it's not uncommon from where I sit. we have NAIT babies very frequently, as well as babies that bleed, drop their plts, need to go to surgery, and we bump their platelets first.
  9. If the antibody is no longer present in this pregnancy, then so far, so good! but some antibodies can wax and wane, and if this fetus is positive for an 'offensive' antigen, that antibody may start kicking up again in mom during the pregnancy. If you know which antibody caused it last time, you can look up and see if it is one that tends to wax and wane. Personally, I'd be concerned that the mom you describe could have HDFN again with this current fetus if the fetus has the offending antigen and mom's immune system catches wind of it. I am unclear on the recommendation that titering would only be done with the first pregnancy - our titer levels are what trigger OBs to order Dopplers for fetal anemia, so I don't know how titers could just be passed over simply b/c it's a different pregnancy. We often see the same woman come back across years with multiple pregnancies, and yes, if we find a clinically significant antibody, we do start chasing titers, regardless of whether she has ad the antibody in the past.
  10. We've had this happen also, and in a perfect world I'd prefer the OBs resume titers in a bit (give the RhIg time to wane) to see if anti-D is shooting up. We've been burned twice in the past six months where OBs stopped checking titers and switched to Dopplers, which showed decreased risk of fetal anemia, and the babes came out with peripheral blood full of erythroid precursors - right on down to erythroblasts - requiring emergent exchange. So I personally would request a repeat titer closer to delivery, just so you know what you may be dealing with. I don't trust the Dopplers (sorry, radiology!)
  11. Also low in southern new england; we were unable to make a full Rh-neg MTP pack this week for an Oneg postpartum bleed.... fortunately they didnt use all the reds and the Rh-pos came back to us. eesh!
  12. Malcolm, thank you for the article! I hope to get to it today. It appears cff DNA testing is available in the US for some things (DiGeorge, for instance), but I am not readily finding a lab that offers RHCE testing. Am going to keep looking. I guess my main concern is that since anti-c can kick up later in pregnancy, if we see an early anti-E in mom, should we advise to 1) test dad (or fetus with cff if i can find it) for not just E but also c antigen and/or 2) request an additional screen later in the pregnancy to see if anti-c has come up? (presuming mom is c-negative)
  13. ahh, i've been at a specialty hospital for too long, i forgot FOB is also fetal occult blood. :-)
  14. oops, John C. Staley - sorry for the abbreviations! MFM = maternal-fetal medicine; FOB = father of baby
  15. Hello, all - We've been having some back and forth with our MFM department and their handling of maternal antibodies. When the mom has an antibody, they test dad for the antigen, and then stop following if negative, and are resisting any change to this (see below for why i find this a problem). I pulled the ACOG Practice Bulletin 192, March 2018 and indeed that is the standard of care per ACOG (although there was NO reference for that entire section of the paper, so i dont know where that info came from). However, we had a case (with MFM) earlier this year where mom had an anti-E on her initial T+S, and they tested dad, dad was negative, so they stopped following.... Then six months later just before delivery we find an anti-c with a roaring titer, with a problematic outcome. So I am kinda not OK with just testing dad and letting it all go when it comes to Rh antigens. Any words of wisdom here? I am going to be tangling with MFM over policy in the new year, and this is certainly on the docket. thank you -
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